The
World Health Organization produces a report every year on the health of
the world population, based on statistics compiled from the 193 member
states that form the United Nations. The latest report shows that, in
the developing world, life expectancy is shorter than in OECD countries,
women are more prone to die in childbirth and babies are more likely to
die before the age of five.

Thereportillustrates
that global inequalities in healthcare are much greater than they were
30 years ago. While people in the West can expect to live until their
late 70s, people living in poor countries, such as Burkina Faso or Chad,
are unlikely to live beyond 46 or 47 years of age. In Africa, half the
population lives on less than US$1.25 a day with little or no access to
safe water. According to the UN, 12 million people die of preventable
diseases every year, often caused by water-born parasitic diseases like
dysentery, insect-born parasitic diseases such as malaria, or from other
factors related to wider economic and social problems such as
malnutrition and lack of medical care.

Poverty
Leads to Poor Health

Rather
than climatic conditions or complex epidemiology, specialists note that
the major causes of ill health for people in developing countries relate
to poverty and underlying political and social conditions. This direct
causal link between poverty and ill health has long been recognized by
many civil society organizations thathighlightpoverty
as the "biggest epidemic" facing the global health community, thereby
emphasizing the importance of economic policy as a health issue.

According to the mostrecentWorld
Bank development indicators, 1.4 billion people were living on less than
US$1.25 a day in 2005. A further 2.5 billion people were living on less
than US$2 dollars a day, meaning that at least 45 percent of the world's
population exist in a state of absolute or relative poverty, including
half of the world's children. In contrast, the world's 497 billionaires
(approximately 0.000008% of the world's population) have an
estimatedwealth
of US$3.5 trillion (over 7 percent of world GDP).

The
WHO'sCommission
on Social Determinants of Healthhas
also recently acknowledged that the high burden of illness responsible
for premature loss of life arises in large part because of the poor and
unequal conditions in which people live and work. The appalling living
environment for millions of people is, in turn, the consequence of
deeper structural conditions - what the Commission calls the ‘structural
drivers' of global health inequality.

The
promotion of social and economic equity, which the WHO and many civil
society organisations maintain is central to respecting human rights
obligations in health, therefore depends upon "narrowing the gap"
between the worst off and best off over time. This process involves "a
progressive flattening of the health gradient", says the WHO Commission,
by improving the health of all social groups to a level closer to that
of the most advantaged. Put simply, the unacceptable discrepancy in
living standards between the developed and developing countries, with
almosthalf
the world-
some 2.5 billion people - living on less than US$2 a day, is a
fundamental factor in the global crisis of ill health.

Access
to Basic Medical Care

But why
does poverty mean that people are more likely to suffer from ill health
or serious illness? In simple terms, poverty often means people lack
access to medical services. Even where healthcare is available, poor
people cannot afford to pay for it or it is prohibitively expensive. As
theWorld
Health Statistics 2009reveal,
people in the poorest countries paid 85 percent ‘out of pocket' for
their healthcare costs in 2006. More than 60 percent of medication in
low-income countries is only available through the private sector, where
the cost is more than six times the international market price. The
poorest people suffering from the worst health outcomes due to poverty,
in other words, are forced to pay the highest proportionate costs for
healthcare.

Access
to Clean Water

The lack
of access to clean water and sanitation is also part of a state of
poverty that has both direct and indirect health consequences for the
poor. An
estimated2.6
billion people - about 40 percent of humanity - lack adequate
sanitation, and over 1 billion lack access to adequate water sources.
Consequently, 5,000childrendie
each day because of a lack of safe, clean water. For millions of others,
the daily grind of searching for and collecting water remains an aspect
of poverty that transcends the notion of ‘basic' needs. In northern
Ghana, for example, girls can spend up to five hours a day fetching
water, whereas women may have to wait for hours at a standpipe in a city
each day.

Medically, the ingestion of contaminated water can lead to a variety of
preventable illnesses, such as cholera, typhoid and dysentery. There
were 131,943 cases of cholera infection alone in 2005, resulting in the
death of 2,272 people across 52 countries - most of them in Africa. Once
the cause of death for thousands in Europe during the nineteenth century
before its spread was understood, the disease has since been eliminated
from most Western countries.

Cholera,
like most waterborne diseases, is completely preventable and could be
eliminated through the provision of clean water and adequate sanitation.
According to the WHO, however, it is spreading again in many developing
countries, especially across South America and Africa. Aid agenciesestimatethat
the return of Cholera to Zimbabwe during 2008 killed 4,000 people and
inflected close to 100,000 others.

Access
to Education and Knowledge

Over one
billion people, the majority of them women, lack the basic education
needed to understand the causes of ill health and take appropriate
preventive action. As widely recognized by UN agencies including the
WHO, World Bank, UNAIDS and UNESCO, education dramatically affects
health outcomes. With better knowledge about HIV/AIDS, for example, many
individuals can be directed towards safe sexual behavior and reduced HIV
infection rates.

Educated
women are more likely to use health services and health-related
information, with a particular impact on child and maternal mortality
rates. According toUNICEF,
each extra year in maternal education in low-income countries reduces
under-five child mortality by up to 10 percent. By enabling more secure
employment and better access to economic assets, education also improves
health outcomes in providing some protection from such shocks as ill
health, disability or natural disasters.

The
current distribution of education, however, is heavily skewed against
girls, those people living in rural areas and the poor. Despite the
pledge of signatories of the Millennium Development Goals to achieve
universal primary education by 2015, children still have to pay for
primary schooling (through either user fees or other charges) in92
countries.

Such
discrepancies in education can also be seen in the control of medical
knowledge. Health specialists in the North know how to control most of
the infectious diseases that afflict low-income countries. Rich nations
should be sharing this knowledge and helping with the alleviation of
preventable diseases by ensuring that public health and sanitation be
provided for all, together with clean water, adequate housing,
education, adequate food and health education. These measures would go a
long way towards the elimination of diseases that currently afflict
people in developing countries, just as they were successful in
improving the health of European and American citizens in the nineteenth
century.

Structural Causes of Poverty and Ill Health

It is
clear that the crisis of global health is intimately related to the
crisis of global poverty. However, whilst the direct causes of ill
health in the developing world can be attributed to a lack of resources
and poverty, if we delve deeper, we can state that a major source of
poverty itself is the current structure of the global economic system.
This understanding - that improving global health is impossible without
addressing the wider political and economic causes of poverty - is
central to an agenda for human development and social justice.Debt and Structural Adjustment

Structural adjustment policies and high levels of debt owed by Southern
countries to institutions in the North remain a key reason for worsening
health outcomes in many developing countries. Following the oil crisis
in the 1970s, Southern debt suddenly soared due to interest rate hikes
and the devaluation of the US dollar. Many economies in the 1980s,
collapsing under an unmanageable debt burden, were forced to enter into
loan agreements with institutions such as the International Monetary
Fund (IMF) and the World Bank.

These
loans were contingent upon the adoption of fiscal austerity measures and
economic reforms, later commonly known as ‘structural adjustment
programs' (SAPS). Under the rationale of attracting foreign investment
through market liberalization and downsizing the public sector,
adjustment measures included the rapid privatization of state
industries, the removal of ‘barriers to trade' such as tariffs and
quotas, and often led to social spending cuts in essential services such
as education, health, housing, water and sanitation.

The
human impact of structural adjustment has since become legendary; real
wages fell by as much as 70 percent in some African countries in the
1980s, while the introduction of user fees for healthcare led to a
catastrophic drop in usage of health services. Poverty and hunger rates
considerably worsened in many indebted nations, health systems
collapsed, children left school, and government-provided social services
and safety nets were seriously undermined.

Structural adjustment also did little to curb the Southern debt crisis,
which spiraled upwards by 400 percent to reach a level of US$3,000bn by
the late 1990s. The devastating human consequences of SAPs have since
led to their abandonment, although their replacement with Poverty
Reduction Strategy Papers (PRSPs) in 1999 has resulted in policies
little different from SAPs. Even today, the IMF promotes an expansion of
private-sector healthcare delivery in poor countries, with the same
market-led approach to development leaving little scope for ambitious
public health programs.

Unfair
Trade Rules

Unfair
trade rules also negatively influence health outcomes in poorer
countries by exacerbating conditions of poverty and food insecurity. The
World Trade Organization (WTO) members meet to set the rules of world
trade, almost always in favor of the rich countries, to the detriment of
the poor. Whilst more economically powerful countries continue to
subsidize their agro-export corporate farmers, the same countries insist
that developing nations reduce their own subsidies and lower tariffs and
quotas on the import of foreign goods.

Similar
to the requirements of market liberalization under structural adjustment
policies, the WTO's Agreement on Agriculture commits member countries to
remove tariffs and subsidies for farmers and food exporters. The current
terms of trade, however, remain grossly unjust. While Southern countries
are expected to do away with agricultural subsidies, remove trade
barriers and open their markets to foreign goods, farmers in the North
continue to be supported by huge government handouts. In 2005, for
example, the US subsidised its agricultural products to the tune of
US$19bn. These heavily subsidized products flooded the Asian rice
markets, the African cotton markets and the Latin American soya markets,
undermining local markets, and driving millions of Third World farmers
and peasants into bankruptcy. As India's Trade Minister said at the Doha
world trade talks in 2005; "Indian farmers can compete with US farmers
but not with the US Treasury."

A major
consequence of massive subsidies in the North is the overproduction of
agricultural commodities, leading to the ‘dumping' of food at below
production costs in developing countries. Subsidies in the United
States, forexample,
have allowed US businesses to sell wheat on international markets at 43
percent below the cost of production, rice by 35 percent and cotton by
over 60 percent. The effect of such dumping on farmers in the South can
be devastating; not only are millions of smallholder farmers displaced
from their livelihoods, but billions of dollars are lost each year in
agricultural income for developing countries.

Agricultural and rural investment has also dramatically declined in poor
countries over recent decades. According to the World Bank, agricultural
productivity per worker has fallen by about 12 percent in Africa since
the early 1980s, while yields of the most important staple food grainshave
not increasedover
the same period - a situation repeated across the developing world.
Following the liberalization of the agricultural sector, these factors
have led to a collapse in rural employment and farm incomes in many
poorer countries.

Increasing imbalances in the division of land ownership are a further
obstacle to economic development in the South. In poor countries, a
small number of large landowners possess most of the arable land, while
vast numbers of small owners and tenants farm the remaining soils, which
is often of inferior quality or on marginal lands where environmental
degradation threatens agricultural production. Fewer and fewer
households are able to subsist on herding, forestry or fishing.
Commercial fishing reduces the catches of poor fishers, and foresters
lose their rights to logging companies working under government
concessions. The globalised food system has therefore created a perverse
and paradoxical dynamic; the use of land for export production may
reduce food costs in countries with advanced economies, but it can have
tragic consequences for most of the families who live from farming in
the developing world.

Global
trading rules are also biased in favor of large agro-industrial
businesses that grow crops for export, thereby penalizing small farmers
who grow food for local consumption. The average land holding per head
among rural farmers in developing countries declined from 3.6 hectares
in 1972, to 0.26 hectares in 1992 - and continues to fall. Unfavorable
market conditions can also cause these families to fall into debt,
forcing them to sell their land and migrate to urban areas. Estimates by
the UN in 2000 suggested that up to 30 million people had been driven
from rural areas as a result of agricultural liberalization policies.

With a
vast number of hungry people living in farm households, these structural
conditions are a major cause of food insecurity and increasing poverty -
leading to the social and environmental settings that are a major cause
of ill health. WTO rules and free trade agreements encourage governments
to prioritize trade concerns and business needs over public health needs
and social spending, in effect trumping the right to health with the
priorities of ‘export-led growth', positive terms of trade and the
shareholders right to maximize profit.

The
Power of Transnational Corporations

The
process of economic globalization has led to the concentration of power
in the hands of a small number of transnational corporations, resulting
in the accumulation of huge profits in the midst of chronic food
insecurity and poverty for millions of people. As markets were
liberalised and the role of governments scaled back over the past few
decades, private property rights were strengthened through trade
agreements, in particular the Trade-Related Aspects of Intellectual
Property Rights (TRIPS). Simultaneously, regional and bilateral trade
agreements - signed at a rate of 15 per year in the 1990s - handed more
power to large corporations, resulting in dramatically increased volumes
of world trade.

The
rapid growth of foreign direct investment (FDI) since the early 1990s,
generally involving a company from one country making a physical
investment into building a factory in another country, has also led to
the immense influence of transnational corporations (TNCs). This trend
is most notable in the food industry where large corporations dominate
the whole supply chain, from the seeds planted in fields through to the
production, processing, manufacture, marketing and selling of food to
consumers. By 1990, for example, companies from OECD countries
controlled 90 percent of the global seed market. Between 1990 and 2001,
the foreign sales of the world's largest food-related TNCs rose from
US$88.8bn to US$234bn, with total foreign assets rising from US$34bn to
a spectacular US$257bn.

The
result is a global trading regime subjugated to control by
Northern-based TNCs, and a so-called ‘race to the bottom' for workers in
developing countries. The liberalization of capital and trade markets
has made it easier for TNCs to operate wherever the conditions are best
suited to maximizing the return on investments, allowing them to quickly
move into countries with cheaper labor or more natural resources to
exploit. Entire operations are often transferred into low wage and low
tax countries with less environmental or labor protections, or ‘special
economic zones' (SEZs)
are set up in poorer countries that allow TNCs to operate with
exemptions from certain taxes and business regulations. In 2004, 5,000
SEZs worldwide employed around 50 million workers. For many jobseekers
in the South, poverty and unemployment force them to accept unhealthy
working conditions and insufficient wages, in turn exacerbating the
social determinants that lead to ill health. The employment trend in
Northern countries is also towards downsized workforces, casual contract
labor with less social protection, and increased job insecurity.

The
privatization of health and other essential services, which has gone
hand in hand with the neoliberal ideology that still defines the
macro-economic system, has also increased the power of transnational
corporations based in the North. In most developing countries,
market-driven health sector reforms intensified in the late 1990s under
policies dubbed the ‘Washington Consensus' (led by the World Bank, IMF,
WTO and United States), based on the assumption that government-run
services were uneconomical and inefficient. Health insurance schemes
flourished alongside a mix of public and private options for healthcare,
often producing a two-tiered health system in low- and middle-income
countries as a result of packages designed by the World Bank - meaning
one for the rich who could afford choice, and a deficient version for
the poor.

The
effect for those who could not afford user fees or the Bank's ‘best buy'
health interventions was often disastrous. In sub-Saharan Africa,
primary education levels fell by as much as half between the 1960s and
the 1990s, while many diseases of poverty once thought ‘conquered' made
a sudden return such as tuberculosis and dengue fever. The public
sector, far from being supported by unregulated privatized health
services, was increasingly eroded. And the international trend towards a
privatized world has effectively redefined the concept of health from an
inalienable human right, to a commodity to be bought and sold on the
market. Even in the traditionally welfare states of Europe, hard-won
gains of publicly accountable services are being gradually eroded by a
market-driven health sector.

This
strong intellectual property regime, pushed by the US, EU and Japan at
the WTO on behalf of their pharmaceutical companies, has also limited
access to medicine for the poorest in the developing world. Under TRIPS
agreements, governments grant patents to give a company monopoly power
to manufacture and sell a medicine free of competition from any other
manufacturer in that particular country, usually for a period of ten
years. Such an imposed monopoly significantly increases the price of
essential drugs, such as antiretroviral medicine for HIV/AIDS, as well
as legally restricts the ability to produce ‘copy-cat' drugs that
provide a lifeline for many of the world's poor.

Furthermore, the intellectual property regime and the vast profits that
can be secured from patented drugs has skewed the incentives for
research and development of drugs away from the needs of the poor in the
developing world towards ‘lifestyle medicines' that service the desires
of the richer members of society.

An
unfettered global economic market that disproportionately empowers large
corporations, increases wealth inequality both within and between
nations, and fails to eradicate poverty and food insecurity is clearly
incompatible with public health objectives. The globalised market system
has not worked for the poorest people who lack the resources to fulfill
the human right to "a standard of living adequate for the health and
well-being of himself and of his family, including food, clothing,
housing and medical care and necessary social services". Only a new
model for development can meet this vision as enshrined in
Article 25of
the Universal Declaration of Human Rights, based on a rehabilitation of
the public sector and public services, a reinvigorated notion of the
government role in providing essential public services, and a
transformed economic system that specifically prioritizes health and
social welfare.

The Need
to Implement the Principle of Sharing

In 1978,
the World Health Organization held an international conference at Alma
Ata in Kazakhstan to discuss the importance of Primary Health Care. Out
of this conference came theAlma
Ata Declarationsigned
by 134 countries, which stated that Primary Health Care (PHC), rather
than expensive high-tech medical interventions, could provide the
solution to the problems of world health. The radical concept of PHC
went entirely beyond traditional healthcare delivery models to
incorporate a spirit of social justice and universal equality, as
embodied in the slogan ‘health for all by the year 2000'. Health is "not
merely the absence of disease or infirmity", stated the Declaration, but
a "fundamental human right" and a "world-wide social goal whose
realization requires the action of many other social and economic
sectors in addition to the health sector".

The Alma
Ata Declaration also embraced the proposals for a new international
economic order, put forward by the United Nations in the 1970s, to
reform the global economy to promote equality for Third World countries
as well as replace the Bretton Woods system. The aim of ‘health for all'
therefore had explicitly political implications based on "sustained
economic and social development" in order to reduce the gap between the
health status of the developing and developed countries. For the first
time, two complementary understandings of healthcare were forged
together; both the clinical determinants of health, as well as the
social, political and economic determinants of health that are largely
beyond the control of health ministries. Most importantly, PHC as the
declared model for global health policy called for a more equitable
distribution of resources between rich and poor - in other words, a
fairer sharing of wealth and power that would soon become anathema to
the advocates of neoliberal policies.

The
idealism of equality and sharing that brought the world together in Alma
Ata obviously did not last for long, almost immediately replaced by the
World Bank's focus on ‘selective primary health care' that had the less
ambitious goal of fighting specific diseases based on ‘cost-effective'
medical interventions. This approach, characterized by a disease-focused
and vertical model that only targeted a limited range of illnesses and
health needs, ignored the broader context of development and the
principles of social justice and equity. The lofty goals set at Alma Ata
were soon overshadowed by the structural adjustment programs led by the
International Monetary Fund and World Bank, which incorporated
competition into the provision of social services and led to the
slashing of health budgets in many poor countries.

The
World Health Organization, that previously pioneered the concept of PHC
in the 1970s, also remained conspicuously silent during the years of
market-driven health sector reforms. A UNreportsummed
up the state of health in 2003 in calling for a re-examination of
current strategies to meet targets on reducing poverty, hunger and
illness: 54 countries had become poorer than they were in 1990, it
reported, and life expectancy had regressed in 34 countries, mostly in
Africa.

Yet the
spirit and vision of Alma Ata was never entirely forgotten. In 2000,
when governments were originally scheduled to meet the goal of "the
attainment by all peoples of the world... of a level of health that will
permit them to lead a socially and economically productive life", a
civil society gathering called the
People's Health Assemblytook
place in Bangladesh and called for a renewed international commitment to
primary health care.

The People's Charter for Healththat
was formulated and endorsed at the five-day gathering soon became the
common tool of a worldwide citizen's movement committed to making the
Alma-Ata dream a reality. On the thirtieth anniversary of the
Declaration of Alma-Ata in 2008, the People's Health Movement againreiteratedits
call for ‘Health for All Now!', while theOuagadougou
Declarationon
Primary Health Care was issued in Africa in April 2008, also calling for
a renewal of the Principles of Primary Health Care and its
implementation in developing countries by the international community.

Of
these, the previously mentioned CSDH report is of particular note.
Although media coverage of the report was minimal, some health policyanalystsdescribed
the findings as little short of revolutionary. The Commission - set up
in 2005 by the WHO to address the social factors leading to ill health -
stated that "deep inequities in the distribution of power and economic
arrangements, globally, are of key relevance to health equity." In an
entire section headed "Tackle the Inequitable Distribution of Power,
Money, and Resources", the final report identified these factors as the
key "structural drivers of the conditions of daily life". The fact that
a majority of people in the world do not enjoy the good health that is
biologically possible, it states, is by no means inevitable but the
result of a "toxic combination of bad policies, economics, and
politics". A fairer sharing of world resources is thus, in no uncertain
terms, taken as the starting point for addressing inequities in health
as well as all other aspects of human development.

In a
stinging critique of globalization, trade liberalization, market
integration, and multilateral organizations such as the IMF, World Bank
and WTO, the CSDH report goes a long way towards defining a new
international economic order - despite specifically stating that such a
task was beyond its remit. Significantly, the report in its final
chapter recognises that its ambitious agenda is dependent upon a "global
movement for change", involving not only the World Health Organization,
global leaders and country partners, but also civil society as "powerful
protagonists in the global health equity agenda."

While
the issue of healthcare again grabs news headlines with the national
reforms proposed by President Barack Obama in the United States, demand
for a renewal of primary health care based on equality is silently
gaining renewed attention amongst policymakers. For the WHO to fulfill
its mandate and live up to the bold analysis in its CSDH report, civil
society organizations must play a central role in pushing through a
policy platform based on the principles of PHC. The next step, as the
People's Health Movement has long recognized through its global campaign
on theRight
to Health,
is for popular public support to mobilize attention around the issue of
‘health for all' - recognizing the central role of the state and public
health systems, and the ultimate responsibility of the United Nations in
holding governments to account for universal human rights norms. When
the principle of sharing is accepted as fundamental to the provision of
adequate food, shelter, health care and education, then the fine words
of the UN's many declarations can finally be translated into a concrete
programme of action.

ANNEX

Diseases
in the Developing World

Many of
the diseases in the developing world should be entirely preventable with
modern medical knowledge and an understanding of the structural causes
of poverty.

The
examples below illustrate some of the diseases that commonly afflict the
developing world, and how a fairer sharing of world resources could help
to alleviate them.

Bilharzia and Hookworms

Two
billion people worldwide suffer from Bilharzia (schistomiasis) and
soil-transmitted parasitic worms, mainly hookworms. Over the past few
decades, incidents of schistosomiasis and hookworm have increased and
continue to spread, especially in African countries such as Ghana,
Senegal, Ethiopia and Mali. Estimates suggest that Bilharzia and
soil-transmitted parasitic worms account for more than 40 percent of all
tropical diseases, excluding malaria.

A fluke
or schistosome parasite causes Bilharzia or Schistosomiasis, which
spends part of its life cycle in a water snail and develops in humans.
Infected people and their livestock, urinating in water where snails are
not yet infected often spread the disease to new areas. Several
scientists, including Brinkmann, have found a high incidence of
schistosomiasis in areas near imposed infrastructure projects such as
artificial lakes and irrigation projects.

Strong
government intervention can play a critical role in addressing these
diseases. For example, the Chinese government managed to reduce the
number of people infected in its country from 12 to 1.3 million, through
an integrated control programme involving the ministries of Public
Health, Agriculture and Water Conservancy. The Chinese authorities also
realised the importance of health education in the control of the spread
of the disease, so health agencies taught local populations how to
prevent its transmission, how to treat it and the importance of
cooperation with medical workers for diagnostic screening and treatment.
Local people provided the labor, money and material for snail control.

Improved
water supply and sanitation, according to the World Health Organization,
could also help to prevent the spread of Bilharzia or Schistosomiasis.

Just as
schistosomiasis has spread over the past few decades in poorer
countries, so has the incidence of hookworm. Hookworms live in damp
earth and enter people through the soles of their feet, travelling
through the bloodstream to the intestines, where they live indefinitely.

Irrigation projects worldwide again appear to contribute to the spread
of the disease. According to the World Health Organization "intensified
irrigation, dams and other water related projects contribute importantly
to this disease burden".

If the
principle of sharing was implemented, governments in the North could aid
the World Health Organization to alleviate incidents of schistosomiasis
and hookworm.

·
Both schistosomiasis and hookworm are eminently treatable with cheap
drugs, meaning that more wealthy governments should provide drugs
required to treat all the people suffering from schistosomiasis and
hookworm

·
Educational projects should also be put in place in poorer countries to
teach people how to prevent the spread of these diseases

·
Adequate sanitation facilities should be provided, to prevent the spread
of these diseases

·
People in danger of contracting the diseases should be supplied with
footwear, to protect their feet

Filariasis

Lymphatic filariasis (also known as elephantiasis), dracunculiasis,
onchocerciasis and malaria, are also spread by water borne parasites.
One billion people in 80 countries are at risk of infection by
elephantiasis, so called because the legs of people infected with the
disease swell up to the size of an elephant. Furthermore, 120 million
people globally are infected with this disfiguring disease, which is
caused by a parasite that lives in mosquitoes. Doctors can now treat the
disease with albendazole, a drug developed by GlaxoSmithKline and Merck.

Lymphatic filariasis could be adequately treated if governments helped
to integrate participatory programmes for the elimination of this
disease, both by treating infected people and preventing the spread of
the disease through the provision of adequate housing and bed nets.

Malaria

Malaria,
caused by the plasmodium parasite, remains endemic in many Third World
countries. 1,600 million people are at risk of infection with malaria
worldwide, whilst 396 million people (of which 275 million in Africa)
suffer from the disease. The World Health Organization estimates that
1.4-2.8 million people, most of whom are children under five, die from
the disease every year.

To
control Malaria, both early prevention and direct treatment are
important. In the West, many governments have largely eradicated
Malaria, where it previously affected millions. Although it may be
impossible to eradicate mosquitoes totally, with modern medical
knowledge and global financial resources, it could be easily achievable
to treat all those people that are infected. In addition, a strong
government role in healthcare provision would help to alleviate malaria.
By using organized quarantine methods, infected patients could be
isolated to remove the threat of contamination to other mosquitoes and
humans.

Donors
should provide money for integrated malaria control programmes,
combining participatory mosquito control with screening and treatment of
infected people in all the countries affected. Every source of stagnant
water, where mosquitoes can breed, should be removed and natural methods
of eradication could be enhanced to eliminate the remaining mosquitoes
(harmless biolarvicides developed in Cuba and currently produced in
Argentina by Rosenbush laboratories provide one example).

Dracunculiasis

Dracunculiasis is caused by a parasitic worm, the Guinea worm (Drancunculus
medinensis), which spends part of its life cycle in a water flea, and
develops in the human body. People catch guinea worms from unclean water
in the poorest parts of sub-Saharan Africa, especially in Sudan. The
worm migrates under the victim's skin causing severe pain, especially
when insertion occurs in the joints. It eventually emerges from the
feet, making them swell, blister and ulcerate, accompanied by fever,
nausea and vomiting. Although no drug treatment is available, the
disease should be completely preventable. In the 1970s, there were
several million cases. The World Health Organization made a serious
effort to eradicate the disease and there are now 75,223 cases, most of
which are in the Sudan.

Through
cooperation and an effective sharing of resources, the Guinea worm could
be completely eradicated through the implementation of a proposed World
Health Organization programme by:

·
Case containment in all endemic villages

·
Community-based surveillance systems in endemic villages

·
Providing safe water, health education and water filters

·
Mapping all endemic villages and maintaining data bases

·
Certifying guinea worm eradication country by country worldwide.

River
Blindness

Half a
million poor people living in Africa have lost their sight due to river
blindness, or onchocerciasis, an insect-borne disease caused by the
parasite Onchocerca volvulus and transmitted by blackflies that live on
the banks of fast flowing water. Adult worms of the parasite live in
nodules in a human body where the female worms produce high numbers of
larvae called microfiliariae. These worms then break out of the nodules
and find their way to the surface of the skin. Eventually they make
their way to the eyes, causing blindness. If caught in time the disease
can be treated with the drug ivermectin, or mectizan, a drug developed
by GlaxoSmithKline and Merck.

Since
1996, the African Programme for Onchocerciasis Control has introduced
mass community-based ivermectin treatment control programmes. A similar
programme was set up in South America by the Onchocerciasis Elimination
Programme in the Americas. The World Health Organization formed a
Nongovernmental Development Organization Coordination Group for
Onchocerciasis Control to promote worldwide interest and support for the
use of ivermectin in countries where people suffer from river blindness.
So far, the programme has been successful and points the way forward
towards the importance of sharing responsibility for the control of some
of the world's most debilitating diseases.

Sleeping
Sickness

Sleeping
sickness is another disease that seriously affects the poor, with at
least 50 million people in 36 African countries exposed to the risk of
contracting this disease. A parasite, the African trypanosome that lives
in the tsetse fly, transmits this disease by biting humans. The parasite
lives in the blood of the infected person for a few days, then travels
into the brain, where it begins to cause sleep disturbances, eventually
killing the infected person.

Colonial
powers in Africa in the 1940s and 1950s were almost successful in
bringing sleeping sickness under control. They trained local Africans to
recognise the relevant parasites under the microscope, took blood
samples from every man, woman and child, then treated everyone that had
trypanosomes in their blood. The treatment was harsh. People suffering
from the early stages of the disease were treated with suramin and
pentamidine, both of which have severe side effects, and people already
suffering from the late stages of the disease were treated with the
arsenic-based drug, melarsoprol, which kills more than ten percent of
those treated.

However,
there are more effective and humane ways of preventing sleeping
sickness, by the eradication of tsetse flies. Experiments in certain
African countries proved that tsetse flies could easily be caught in
traps that are cheap to make using sticks and cow-urine-impregnated
cloth. Such natural solutions and participatory projects should be
implemented in all 36 African countries affected.

Leishmaniasis and Chagas Disease

An
estimated 200 million poor people in Africa, the Americas and Asia are
at risk of infection with the Leishmania parasite. Leishmaniasis is
transmitted by phlebotomine sandflies. This disease can either affect
the skin, causing sores, or the internal organs, causing Kala Azar,
which is fatal if not treated. Drugs used to treat leishmaniasis are
based on antimony (a toxic heavy metal), have to be administered by
injection under medical supervision and can cause severe side effects.
The Leishmania parasite has become increasingly resistant to these
drugs.

In South
and Central America the poor are also at risk of infection with Chagas
disease, caused by the American Trypanosome parasite, (Trypanosoma
cruzi), which lives in the assassin bug. An estimated 649,000 people are
infected with this disease. Assassin bugs, which live in the cracks and
crevices of poor people's homes, usually in rural areas, come out at
night to bite and ingest blood from sleeping humans.

Assassin
bugs transmit parasites through their faeces, which then enter the
bloodstream of a sleeping human, causing fever and swollen lymph glands.
This initial acute phase is sometimes fatal, especially in young
children, but most adults survive and the parasite then invades the
organs of the body, including the heart, gradually debilitating the
person over time. Two drugs, which have severe side effects, Nifurtimox
and Benznizadol, can be used to treat the early stage of the disease,
but once the parasite is established, it cannot be cured.

Both of
these diseases could be prevented by the provision of adequate housing
with nets over windows and bed nets to prevent people from being bitten
by the sandflies, as well as providing the screening of blood destined
for transfusions. Even plastering the cracks in existing houses and
substituting metal roofs for thatch could prevent the spread of the
disease.

Taenia
solium

The pork
tapeworm, Taenia solium, is the most common parasitic infection of the
central nervous system. Although the pork tapeworm usually lives in the
intestine of the people it infects, the eggs from the tapeworm can hatch
out and migrate into the muscles, heart, eyes, brain and spinal cord,
where they form cysts, sometimes causing epilepsy. This disease is
associated with poverty and affects people in South America, Brazil,
Central America, Mexico, China, India, SE Asia and sub-Saharan Africa.

It is
possible to cure people of the pork tapeworm by dosing them with
praziquantel. Clean water and adequate sanitation are also essential for
the elimination of the disease, since if tapeworm eggs pass into water
sources then the parasite can infect the human population.

In 1993,
an international task force for disease eradication declared that
governments and health authorities could eradicate Taenia solium
because:

·
The parasite requires the human to complete its life cycle

·
Tapeworms in humans are the only source of infection for pigs

·
Authorities can control transmission from pigs to humans

·
There is no reservoir of infection in wildlife

Therefore, governments and agencies could control these diseases by
providing through adequate water and sanitation and other ‘up-stream'
interventions to prevent the spread of infected parasites to humans.